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目的观察乌司他丁对重型颅脑损伤后急性肺损伤的治疗效果。方法 100例重型颅脑损伤后急性肺损伤患者随机分为对照组和治疗组,每组50例。对照组常规治疗,治疗组加用乌司他丁治疗。采用ELISA法检测患者治疗前和治疗后10 d血浆白介素-6(IL-6)、C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、S100B蛋白、神经元特异性烯醇化酶(NSE)、胶质纤维酸性蛋白(GFAP)、髓鞘碱性蛋白(MBP)、肺表面活性蛋白D(SP-D)和Clara细胞蛋白浓度,观察治疗后3个月格拉斯哥昏迷(GCS)评分。结果治疗前对照组和治疗组血浆IL-6、CRP、TNF-α、S100B蛋白、NSE、GFAP、MBP、SP-D和Clara细胞蛋白浓度无显著差异;与治疗前比较,对照组和治疗组上述指标均显著降低,治疗组指标显著低于对照组。治疗后3个月,GCS评分显示,对照组恢复良好5例,中度残疾7例,重度残疾11例,植物生存11例,死亡16例;治疗组恢复良好13例,中度残疾14例,重度残疾6例,植物生存8例,死亡9例,治疗组预后显著优于对照组。结论乌司他丁对重型颅脑损伤后急性肺损伤具有显著治疗效果,其机制可能与抑制机体炎症反应从而降低脑肺功能损伤有关。
Objective To observe the effect of ulinastatin on acute lung injury after severe craniocerebral injury. Methods 100 cases of severe acute lung injury after traumatic brain injury were randomly divided into control group and treatment group, 50 cases in each group. Control group conventional treatment, treatment group plus ulinastatin treatment. Serum levels of IL-6, CRP, TNF-α, S100B protein, neuron-specific enolase were measured by ELISA before treatment and 10 days after treatment. (GSP), MBP, SP-D and Clara cell protein concentrations were observed. Glasgow coma (GCS) was observed 3 months after treatment. score. Results There was no significant difference in plasma protein levels of IL-6, CRP, TNF-α, S100B protein, NSE, GFAP, MBP, SP-D and Clara before treatment in the control group and the treatment group The above indicators were significantly lower, the treatment group indicators were significantly lower than the control group. Three months after treatment, the GCS score showed that the control group recovered well in 5 cases, moderate disability in 7 cases, severe disability in 11 cases, plant survival in 11 cases and death in 16 cases. The treatment group recovered well in 13 cases, moderate disability in 14 cases, 6 cases of severe disability, 8 cases of plant survival, 9 cases of death, the prognosis of the treatment group was significantly better than the control group. Conclusion Ulinastatin has a significant therapeutic effect on acute lung injury after severe craniocerebral injury. The mechanism may be related to the inhibition of the inflammatory reaction and the decrease of brain injury.